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Odd Case; Odd Test Results (Worth the Read)
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Odd Case; Odd Test Results (Worth the Read)

I'm an 18 year old white female. I've never had the "typical" clustered blister outbreaks characteristic of HSV-2. The last genital acquisition date would have been June of 2010, if my partner lied about his virginity status.

In September 2010, I began developing a progressive undiagnosed autoimmune disorder. I've had a few yeast infections in the past months, likely due to prednisone and weekly doses of methotrexate, or prolonged high doses of antibiotics for an infection while I was immunosuppressed.

Each (2 or 3) yeast infection (itchiness, redness) went away within a week of antifungal treatment, but I can't be 100% sure if these weren't some form of subtle outbreak.

A small area of abrasion from unintentional friction in my labial sulcus caught my eye in November 2011, and off to the Ob/Gyn I went, 2 days later. It was indeed (now-healed over) abrasion, but she'd blood test me for HSV-1 and 2 to be sure.

As for other non-specific symptoms like fatigue, headache, nerve tingling/pain, and muscle pain, I have had them tack on one by one since coming down with my mystery illness, along with a soup of many, many others.
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Here are my somewhat puzzling test results from over the months:

11/30/11

HSV-1 IgG 0.10
HSV-1 IgM <0.80

HSV-2 IgG 0.06
[*HSV-2 IgM 0.89 EQUIVOCAL*]
HSV-2 IgM IFA Not Detected

1/10/12

HSV-1 IgG 0.05
HSV-1 IgM <0.80

HSV-2 IgG 0.19
[*HSV-2 IgM 1.40 POSITIVE*]
HSV-2 IgM IFA Not Detected

2/27/12

HSV-1 IgG 0.03

HSV-2 IgG 0.04
[*HSV-2 IgM 2.45 POSITIVE*]
[*HSV-2 IgM IFA DETECTED*]

HSV-2 Cervical Culture (no symptoms present, looked normal) Negative
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So, in a span of 3 months, my IgG levels have stayed negative for both HSV-1 and 2. HSV-2 IgM level has steadily risen. The IgM IFA is now showing as detected where it previously had not.

So my question is: What do you make of this?

Are the results suggestive of being in the IgG-negative, but infected with HSV-2 group?

Why did the IgM consistently rise and the IFA change from not detected to detected?

Should I press for a Western Blot test to sort this out?

Is my immune system and production of autoantibodies potentially causing cross-reactivity?
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Again, my last possible genital exposure would have been 6/2010 from giving/receiving oral. Less likely exposure, but possible, I kissed my boyfriend who I was not sexually involved with in 1/2012. Both claim they are virgins.

I have heard cross-reactivity exists with the IgM testing. I had chickenpox (VZV) and mono (EBV) during childhood.

However, I also know 5-10% of those infected with HSV-2 have IgG-negative serology, despite symptoms. I have no other STDs.

My rheumatoid factor is non-reactive, I have had a more in-depth CBC and Complement test come back with somewhat abnormal results:

6/9/11

Red Cell Distribution Width - Standard Deviation (RDW-SD) [L] 38.0
Mean Platelet Volume (MPV) [H] 11.2
Monocytes (MONO%) [H] 10.3%
Immature Granuloctyes (IG%) [H] 0.7%

C4 [L] 14.0
Tags: HSV-2, Genital Herpes, Herpes, Herpes Simplex, autoimmune, IgM test, HSV-2 IgM, HSV-2 IgG, HSV-2 positive, HSV-2 equivocal, HSV, blood work, serology, immunology, Page Dr. House!, Frustration
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101028_tn?1348750963
actually it's not that you don't produce hsv2 igg antibodies, it's that the tests we use only look at a particular portion of the antibody response to herpes and not everyone produces those same parts.  each brand of test looks at something different in the response too.

really, no reason to be thinking herpes. given your history, much more likely related to your disease or even the treatments from it. find a dermatologist to work with you and your rheumatologist to try to get to the bottom of it all. best of luck :)
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101028_tn?1348750963
actually the changes in your igm results are meaningless. they will change from test to test but we actually don't recommend herpes igm testing to be done ever on adults for the purpose of diagnosing herpes. it has a high false positive issue and current CDC recommendations are that it not be done on adults.

many autoimmune diseases also cause genital symptoms. you have no reason to think that you have genital herpes.

best of luck getting to the bottom of all of this and I hope you get better soon :)

grace
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Avatar_f_tn
Thanks so much!

I just worry I might indeed have the virus, since "...a significant percentage of people (5-10%) do not produce antibodies against the HSV glycoprotein G. A small percentage of glycoprotein G deficient HSV isolates have also been reported"  https://laboratoryalliance.com/pdf/HSVweb1.pdf

My concern is IgM may be the only sign of an infection. But I don't really know how you go about finding whether or not you have the particular mutation that keeps HSV-2 IgG antibodies from being produced.

I suppose being extra, extra cautious (if I'm ever well enough to be in the dating world again) won't hurt anyone. I'd be overwhelmed with guilt if I ever gave it to someone from a kiss or the like! Though, I guess there are some things in this world we can never know right this second.
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101028_tn?1348750963
actually it's not that you don't produce hsv2 igg antibodies, it's that the tests we use only look at a particular portion of the antibody response to herpes and not everyone produces those same parts.  each brand of test looks at something different in the response too.

really, no reason to be thinking herpes. given your history, much more likely related to your disease or even the treatments from it. find a dermatologist to work with you and your rheumatologist to try to get to the bottom of it all. best of luck :)
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Avatar_f_tn
Thanks again, you're wonderful and devoted to helping out the scared and confused masses!

My Ob/Gyn had never heard of Western Blot, so I'm poking around for a GYN infectious disease specialist who can maybe better assess my results. I've already got this unknown autoimmune thing, being 100% sure on this would really take a guilt load off my shoulders. I mean, it only takes one unlucky kiss or more to potentially have it, so I can't help but worry in varying degrees :/
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101028_tn?1348750963
honestly, no reason for more testing with blood testing. be seen every time you have symptoms and if they think they look herpetic, a lesion culture will be much more helpful. Not likely this is herpes going on though.
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